What to do when a snake bites you

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The other day, I opened the cupboard, and to my shock, a cobra was curled up in there! I had the presence of mind to shut the cupboard door on it. Thereafter, I quickly called the fire department to remove it. A cobra’s bite is very poisonous, right?

Yes. There are three types of venomous snakes in Malaysia: the cobra, the pit viper and the sea snake.

There are plenty of other venomous snakes in the world, especially in Australia. But only these three are venomous in Malaysia.

Cobras can be recognised by their famous and unmistakable hoods, which flare when they are agitated. The hood is actually an extension of the ribs behind their heads.

Pit vipers can be identified by their pits, which are located between their eyes and nostrils. These pits are temperature receptors, which can sense the body temperature of their prey.

So yes, a viper can sense you when you are close.

Not all vipers are pit vipers, however.

Sea snakes can swim and are usually difficult to identify because they are under water a lot of time. In fact, they can hold their breath for up to an hour under water.

Their tails are flat to allow swimming, and they are from the cobra family. They are extremely venomous. If you see a snake swimming in the water, get out immediately!

I would advise you not to spend too much time trying to identify a snake to see if it is venomous however, if you find one in your house.

It’s best to just move slowly away and call the proper authorities to remove them from your home.

Be on the lookout for snakes as well when you are hiking in the jungle, or camping or doing any outdoor activities.

What happens when a venomous snake bites me?

Snakebite venom contains proteins that are very toxic to the human body. These proteins can be divided into cytotoxins, haemotoxins, neurotoxins and cardiotoxins.

It depends on what type of venomous snake it is. Doctors in the Accident and Emergency (A&E) department are trained to help identify what sort of snake it was that bit you in order to administer the appropriate anti-venom.

When a snake bites you, there is usually the presence of two fang marks at the bite site. Unlike human teeth, the fangs have ducts in them that contain venom from a gland.

The most common feeling you may have from snakebites is a sense of overwhelming fear. This may lead to nausea, vomiting, a very high pulse rate, fainting and cold, clammy skin.

This is in large part due to stories, TV, media and all the hype surrounding snakes!

Not all venomous snake bites result in venom injection from their fangs. But when they do, there is redness, pain and swelling at the bite site, which may take up to an hour to appear.

Bites from cobras and vipers are extremely painful, and the inflammation may appear very quickly – within five minutes.

The bite area may also bleed and blister, and this can lead to tissue death. The bites from vipers, in particular, cause bleeding.

These are all called “local effects”, meaning effects that occur on the body site or area of the bite.

If a non-venomous snake bites me, I will be OK, right?

Not necessarily. Even when a venomous snake bites you and does not inject venom, it can cause tissue injury and infection. This is called a dry snakebite (which are up to 50% of all snake bites).

Same for a non-venomous snakes. The snake’s fangs may harbour a lot of bacteria, and this can lead to infection, including with the microorganism causing tetanus.

Moreover, if you are allergic to snakebites, you can go into anaphylaxis, which can result in severe shock and your body’s organs shutting down.

Are ‘local effects’ all I will get from the snakebite?

Unfortunately, no. The snakebite venom contains proteins that are very toxic to the human body.

These proteins can be divided into:

• Cytotoxin – this causes local tissue damage.

• Haemotoxin – the very name means a toxin that causes bleeding. This not only result in bleeding from the bite site, but also internal bleeding in your body.

• Neurotoxin – this one affects your entire nervous system and can lead to paralysis.

• Cardiotoxin – this one affects your heart.

Help! I have been bitten by a snake and I don’t know what snake it is. I happened to step on it when I was out running in the jungle. What do I do?

Cobras can be recognised by their famous and unmistakable hoods, which flare when they are agitated. The hood is actually an extension of the ribs behind their heads.

Are you alone? You will need help to go to a hospital as soon as possible, so flag down a passer-by and ask for assistance.

Don’t try to catch the snake in order to identify it!

If you can’t find anyone immediately, you still have to try to get help.

Do not try sucking on the bite yourself or allowing anyone else to try to suck the venom out.

Do not attempt to cut out the area of the bite either.

These actions will result in more infection and can damage your underlying organs. They will not remove the venom either.

Also, do not use ice or tourniquets. Tourniquets are not effective and can lose you a limb.

Do not pour alcohol on the bite.

Do take off any constricting jewellery, such as bracelets or rings.

Try not to use the affected limb to delay spread of the venom.

Part two of this article will appear in a fortnight. Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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9 Comments

reader

As many writers have been corrected before, “poisonous” indicates dangerous to eat, whereas “venomous” indicates the capacity to produce and administer venom. This should be the basic for anyone who wishes to write about snakebite.

francis C.

iMBernardOng

I learnt this from An instructor in Outward Bound School. He got bit by a Cobra on his hand. Tear a piece of Cloth tie round his upper arm. Find a stick put it through the cloth then twist the stick till it’s tight enough able to see the veins coming out. Look for the veins that got punture .Stroke that veins from top down. The posionious blood will will go out from the punted hole. Then every few minutes release the stick and twist it back again. Same action or your hand will be paralysed if there is no circulation..then go hospital..The instructor survive for half an hour b4 reaching hospital..just sharing cos it make sense.

CCS

Firstly, IMHO, it shouldn’t be made a big deal whether if it’s poisonous or venomous as the subject here is dealing with bites hence attention should be focused on the bite protocols involved (pre-medical and medical management). To also clear the air, kraits and corals belong to the same family as cobras and sea snakes, elapidae and elapids.

Snakes bites occur through 3 types of exposures (occupational, climatic, and environmental – as obscure as your neighbour could have a house full of hot snakes due to his hobby). Hopefully Preventive Protocols for those exposed to those risks above will be mentioned as it is definitely better than dealing with a bite. A basic profiling (physical attributes, behaviour, colouration, patterns etc) of species that are medically important (MI) and the differences of MI category 1 and 2 will also help to avoid getting bitten, or in the event of getting bitten, how do you describe the species to the doctor before further medical management (some bites share similar symptoms but may differ in treatment). Wrong description of species or size may result in different treatment and can be fatal.

A salient point to add on is that ONLY government hospitals will treat snake bites. Do not waste precious time heading towards a 5 star hospital. However, due to some inherent challenges, the prevailing issue is that most are lacking in quantity or specific antivenins. i.e if a king cobra bites, you are supposed to use only King Cobra Antivenom by Thai Red Cross Society or the King Cobra antivenom by Central Research Institute of India. Hence those constantly exposed should have regular inventory checks with their nearest gov hospital as part of their preventive protocols.

Snake bite is a huge and especially important topic for us who are living in the heart of snake country. Granularity on protocols truly saves lives. Thanks heaps for writing to create awareness on this where most people don’t care.

This article from The Star consist of very faulty fact concerning snakebite and it’s management.

First of all, poisonous is used for substance that cause harm to body either when we ingest them, smoking, smelling, drinking or touching it.

Meanwhile, venomous is more accurate to describe certain type of snakes with the ability to cause significant injury to human.

It is not only cobra, pit viper and seasnakes that are venomous in Malaysia. However, we classify it into Elapids, viperidae, colubridae and phytonidae. Elapids like King Cobra, spitting cobra, Naja Kouthia, kraits and sea kraits are very venomous. While elapids like coral snakes are highly venomous, it rarely caused death to human due to the venom delivery mechanism.

For viperidae, we further classify it into green pit viper complex like Sabah Green Pit Viper, Sumatrana pit viper, Cameron Highland pit viper etc. Or it can be non green pit viper complex like ular kapak bodoh. While viper are extremely venomous, venom of certain species are not strong enough to kill human: for example Ular Kapak Tokong or it’s relative in Borneo called Troipodelema subannalatus.

While Colubridae group is being regarded as non venomous group of snake, two species in Malaysia can cause harm to human. Banded mangrove snake can cause local envenoming effect after being bitten while red neck keelback can caused death after being bitten and envenoming

Having said that, bear in mind that bitten by venomous snake does not equal to you being envenoming by it. Most of the snakebites are dry bites. Expert management in Accident and Emergency Department is required to determine whether the bites is significant or not.

While phyton often end up as delicious dishes to some people in Malaysia, it can cause severe tissue injury if being bitten by it. However, it does not have venom.

Mike

This reply also faulty in several ways. What genus is Troipodelema? Do you mean Tropidolaemus? If can’t get accuracy on small things, which parts should we believe? “most” snakebites are dry implies less than 50%, right? Of pit viper bites, estimated 20% are dry…irresponsible mistake. This above comment keeps good company with the faulty article.

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